Abstract
Trials and real-life studies demonstrated clinically meaningful improvements of disease activity in the majority of patients with moderate to severe atopic dermatitis (AD) treated with the anti-IL-4RA-antibody dupilumab. However, misdiagnosis or confounding skin diseases in particular cutaneous T-cell lymphoma (CTCL) may lead to inadequate response. To investigate the clinical and pathological features of patients with AD who showed insufficient response to dupilumab. We reviewed the medical records of 371 patients treated with dupilumab for severe AD. Insufficient response was defined as failure to achieve an improvement of the eczema area severity index (EASI) of at least 50% (EASI-50) at Week 16 and of 75% (EASI-75) at Week 52. Among 46 patients with insufficient response, 35 patients consented to a re-evaluation including a full physical exam, biopsies and laboratory assessments including immunohistochemistry and T-cell receptor gene rearrangement analysis to differentiate CTCL. Of the 371 patients treated with dupilumab, 46 (12.3%) patients showed insufficient response to dupilumab. Of these, 35 underwent further evaluation, and 19 (54.2% of inadequate responders) were finally diagnosed with mycosis fungoides (MF). In these patients, transition to or addition of conventional MF treatment led to clinical improvements. Insufficient response to dupilumab treatment may help uncover early MF on an existing AD background.
Overview
- The study aimed to investigate the clinical and pathological features of patients with atopic dermatitis (AD) who showed insufficient response to dupilumab treatment. The study reviewed the medical records of 371 patients treated with dupilumab for severe AD and defined insufficient response as failure to achieve an improvement of the eczema area severity index (EASI) of at least 50% (EASI-50) at Week 16 and of 75% (EASI-75) at Week 52. Among 46 patients with insufficient response, 35 patients consented to a re-evaluation including a full physical exam, biopsies and laboratory assessments including immunohistochemistry and T-cell receptor gene rearrangement analysis to differentiate cutaneous T-cell lymphoma (CTCL).
- The study used a retrospective design and included 371 patients with severe AD treated with dupilumab. The patients were evaluated based on their response to dupilumab treatment, and those who did not achieve an improvement of at least 50% (EASI-50) at Week 16 and of 75% (EASI-75) at Week 52 were considered to have insufficient response. The study also included a re-evaluation of the patients with insufficient response, which included a full physical exam, biopsies, and laboratory assessments including immunohistochemistry and T-cell receptor gene rearrangement analysis to differentiate CTCL.
Comparative Analysis & Findings
- The study compared the outcomes observed under different experimental conditions or interventions detailed in the study. The study found that among 46 patients with insufficient response to dupilumab treatment, 35 patients consented to a re-evaluation, and 19 (54.2% of inadequate responders) were finally diagnosed with mycosis fungoides (MF). In these patients, transition to or addition of conventional MF treatment led to clinical improvements. The study also found that insufficient response to dupilumab treatment may help uncover early MF on an existing AD background.
Implications and Future Directions
- The study's findings suggest that insufficient response to dupilumab treatment may be due to the presence of CTCL, which can be diagnosed through a re-evaluation including a full physical exam, biopsies, and laboratory assessments including immunohistochemistry and T-cell receptor gene rearrangement analysis. The study also highlights the importance of considering the possibility of CTCL in patients with AD who do not respond to dupilumab treatment. Future research could focus on developing more effective treatments for patients with AD who have CTCL or on identifying biomarkers that can predict the development of CTCL in patients with AD.